World-renowned Johns Hopkins Medicine forced to suspend program after investigation finds one doctor reviewed 1,500 cases and never found an instance of black lung, denying coal miners disability benefits

Johns Hopkins Medicine suspended its black lung program after an investigation revealed that Hopkins doctors made questionable medical assessments resulting in denied disability benefits for thousands of coal miners.

The findings were part of a year-long investigation titled "Breathless and Burdened: Dying from Black Lung, Buried by Law and Medicine," a joint project by the Center for Public Integrity and ABC News.

The benefit system for miners disabled by black lung “plays out to be a war of competing experts a lot of times,” says Chris Hamby of the Center. “So the miner will have whatever expert he or she can get. Most of the time this is—they'll submit their treatment records and they'll submit records from an examination by a doctor who is certified by the Labor Department.”

“Now, the coal companies also get to choose their doctors, and they send out x-rays that are taken for reinterpretations. And one of the favorite places for about 40 years before it for the coal companies to send those x-rays is Johns Hopkins,” says Hamby.

Judges tend to favor the interpretations of medical records by Hopkins doctors due to the prestige of the Hopkins institution, says Hamby.

Johns Hopkins received millions of dollars from the coal industry for these studies, but there is no indication doctors personally benefited.

One doctor at the center of the investigation is Dr. Paul Wheeler, a Hopkins doctor who oversaw more than 1,500 cases since 2000.

“His negative readings were incorrect in more than 100 cases,” said Chris Hamby of the Center for Public Integrity. “And keep in mind that pathology is just not available in a majority of black lung cases. But when it has been available, our analysis found that a majority of the time it has shown that Dr. Wheeler, his negative readings were incorrect,” said Hamby.

Johns Hopkins published the following statement on their website: “To our knowledge, no medical or regulatory authority has ever challenged or called into question any of our diagnoses, conclusions, or reports resulting from the service no indications doctors personally benefitted….There are no financial incentives associated with with this program for our "B" readers or our radiology department.”

Hamby says that Senator Rockefeller from West Virginia and Bob Casey from Pennsylvania said are using the black lung investigation as support for legislation that strengthens benefits for disabled miners.

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Story Transcript

On Friday, the Baltimore-based, internationally renowned Johns Hopkins Medicine suspended its black lung program after an investigation revealed that in thousands of cases Hopkins doctors found x-rays showed coal minors don’t have black lung, therefore are not eligible for disability benefits. The findings were part of a year-long investigation titled “Breathless and Burdened: Dying from Black Lung, Buried by Law and Medicine,” a joint product by the Center for Public Integrity and ABC News. Johns Hopkins received millions of dollars from the coal industry for these studies, but there is no indication doctors personally benefited.

We are now joined by one of the reporters that broke the story, Chris Hamdy of the Center for Public Integrity, an investigative news nonprofit based in Washington, D.C.

Thank you so much for joining us, Chris.

CHRIS HAMBY, INVESTIGATIVE REPORTER: Thanks for having me.

NOOR: So, Chris, there’s so much we can talk about in the story. We’ll do at least two parts.

One thing that struck me the most is that a big reason why thousands of coal miners were denied their disability benefits was that Hopkins doctors are so well-respected that judges would take their opinion over other judges’–or, sorry, over other doctors’ that found that coal miners had black lung. Can you talk about just the significance of this study and the role that Hopkins doctors played in denying coal miners their disability benefits?

HAMBY: Right. So the black lung benefits system is–a characteristic of that is that it very much plays out to be a war of competing experts a lot of times. So the miner will have whatever expert he or she can get. Most of the time this is–they’ll submit their treatment records and they’ll submit records from a an examination by a doctor who is certified by the Labor Department.

Now, the coal companies also get to choose their doctors, and they send out x-rays that are taken for reinterpretations. And one of the favorite places for about 40 years before it for the coal companies to send those x-rays is Johns Hopkins. And that is in large part because of the credibility that comes with that finding of no black lung coming from Johns Hopkins medicine, because a judge usually will very often, in making a credibility determination, afford greater weight to the experience and the prestige of John Hopkins and the doctors who have been reading these x-rays for 30 or 40 years in some cases.

NOOR: And so Hopkins on Friday shut down its black lung program pending a review, but it’s continuing to defend it. In a statement posted on their website, they say: to our knowledge, no medical or regulatory authority has ever challenged or called into question any of our diagnoses, conclusions, or reports resulting from the service. They also write, there are no financial incentives associated with with this program for our “B” readers or our radiology department. Now, Hopkins did get millions of dollars from the coal industry to carry out these studies. What’s your response to their statement in their continuing defense of their black lung program?

HAMBY: Well, I guess it remains to be seen what exactly happens. That statement was essentially–that was posted immediately after the story, and then they sort of just added the suspension part to the top. So it’s not totally clear what their position is on the black lung program.

But as far as the financial incentives, we did ask them for a lot of information about that, and they initially promised to provide and then did not answer the questions that we asked them about that.

NOOR: Now, a key character in your investigation is Dr. Paul Wheeler, who has been with Hopkins for decades. And, as you write in your reporting, out of over 1,500 cases he’s reviewed in the last decade or so, since 2000, he hasn’t found black lung in a single instance. And in more than 100 cases that you’ve reviewed, there was definitely black lung found in autopsies or biopsies. Can you talk about the role of Dr. Wheeler?

HAMBY: Right. And first I want to be clear that the 1,500 cases, he hasn’t found a case of severe or complicated black lung. He has in a small number of instances found minimally positive readings of black lung, although in some of those cases he’s then later changed his opinion or read other x-rays as negative, so it’s not totally clear. But it’s a very small percentage.

And he’s reading them minimally positive, which the black lung program, you have to prove not only that you have black lung, but that you’re totally disabled by it. A minimally positive reading would usually not be associated with total disability. I mean, it would be hard. It would depend on other aspects, whereas if you find–if you were to read complicated black lung, the miner would automatically receive benefits if that were credited by a judge. And he consistently has not found that. And it’s because he has said that he just–he repeatedly writes in the reports that complicated black lung was primarily seen in drillers working unprotected during and prior to World War II.

So his view is that, you know, this should be a relatively rare disease after the government became involved in controlling coal dust levels in the mines in 1969. And he does not or he doesn’t completely credit, at the least, he has never denied, but he hasn’t accepted the findings of the government that there is a resurgence of the disease.

NOOR: And you’ve spoken to many other experts and doctors who questioned this conclusion he’s come to.

HAMBY: That’s right. And it’s–his views are very particular when it comes to what black lung looks like on an x-ray. And there is some specific things that he’s looking for. And limiting that and not finding black lung or finding black lung very unlikely if it does not meet one of his criteria, as other doctors have told me, you’re going to end up ruling out a lot of cases where the person actually does have black lung and is just not–it doesn’t meet your very high standards for it.

But beyond other doctors offering different opinions, he himself relies–sort of the gold standard of diagnosis for black lung is pathology. So if you’re actually taking a piece of someone’s lung tissue and looking at it, whether it’s a biopsy or, in some unfortunate cases, after the miner has died and you’re looking at an autopsy of that miner’s lungs–and so those cases have actually shown that his negative readings were incorrect in more than 100 cases. And keep in mind that pathology is just not available in a majority of black lung cases. But when it has been available, our analysis found that a majority of the time it has shown that Dr. Wheeler, his negative readings were incorrect.

NOOR: And finally, we’ve talked about the response from Hopkins. But you’ve also received a strong response from lawmakers and unions and coal miners themselves. Talk about what that response has been and what your next steps are going to be with this investigation.

HAMBY: Yeah, we’ve been somewhat overwhelmed at the reaction that we’ve gotten from everyone, lawmakers to lawyers to activists, the typical sort of people that you hear from after a story like this. But also it’s–we’ve heard from coal miners and people who live in Kentucky and West Virginia and Virginia and are really affected by this. And that’s been nice to see. So in addition to Johns Hopkins suspending their program last Friday, we have heard from senators. Bob Casey from Pennsylvania is working with Senator Jay Rockefeller from West Virginia, and they are using our reports to strengthen legislation, to reform the benefits program. And then we’ve also got the organization, the governmental entity–it’s called the National Institute for Occupational Safety and Health–that certifies the readers for black lung, including the doctors at Johns Hopkins. And they recently said that they found the investigation very disturbing and that they were willing to help Johns Hopkins in any way as they go forward from here. And it’s just been sort of an outpouring of support from minors and thanks that has really–it’s really been–it’s meant a lot to us.

NOOR: Chris, thank you so much for joining us for part one of this discussion.

HAMBY: Sure. Thanks for having me.

NOOR: And we’re going to keep on continue this discussion in part two. Thank you so much for joining us.

HAMBY: Thank you.

End

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Related Bios

Chris Hamby’s reporting on the environment and labor has been recognized with awards from the National Press Foundation, the White House Correspondents’ Association, the Society of Professional Journalists and the National Association of Science Writers, among others. He has twice been a finalist for the Livingston Award for Young Journalists, as well as a finalist…

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